# FATHERLY INSTRUCTION FOR REBUILDING MEN LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093572836
- **Authorized official:** MARLON GOOLSBY (CEO)
- **Authorized official phone:** (740) 963-2073

## Contact information

- **Practice address:** 785 BRENTNELL AVE, COLUMBUS, OH 43219-2571
- **Practice address phone:** (740) 963-2073
- **Mailing address:** 785 BRENTNELL AVE, COLUMBUS, OH 43219-2571
- **Mailing address phone:** (740) 963-2073

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | — | NULL | Yes |

## Other

- **Enumeration date:** 02/28/2024
- **Last updated:** 02/28/2024